1. Florida’s Path Forward: Post Title IV-E Waiver and Family First Prevention Services Act (FFPSA)
July 2019

2. Agenda Refresher on Title IV-E Path Forward Initiatives FFPSA
Additional Federal Guidance
Florida Activities / Next Steps

3. Refresher on Title IV-E

4. The Social Security Act
Title I
Grants to States for Old-Age Assistance for the Aged
Title II
Federal Old-Age, Survivors, and Disability Insurance Benefits
Title III
Grants to States for Unemployment Compensation Administration
Title IV
Grants to States for Aid and Services to Needy Families with Children and for Child-Welfare Services
Title V
Maternal and Child Health Services Block Grant
Title VI
Temporary State Fiscal Relief
Title VII
Administration
Title VIII
Special Benefits for Certain World War II Veterans
Title IX
Miscellaneous Provisions Relating to Employment Security
Title X
Grants to States for Aid to the Blind
Title XI
General Provisions, Peer Review, and Administrative Simplification
Title XII
Advances to State Unemployment Funds
Title XIII
Reconversion Unemployment Benefits for Seamen
Title XIV
Grants to States for Aid to the Permanently and Totally Disabled
Title XV
Unemployment Compensation for Federal Employees
Title XVI
Grants to States for Aid to the Aged, Blind, or Disabled
Supplemental Security Income for the Aged, Blind, and Disabled
Title XVII
Grants for Planning Comprehensive Action to Combat Mental Retardation
Title XVIII
Health Insurance for the Aged and Disabled
Title XIX
Grants to States for Medical Assistance Programs
Title XX
Block Grants to States for Social Services
Title XXI
State Children's Health Insurance Program

5. Title IV Part B Child and Family Services Part E
Part A
Block Grants to States for Temporary Assistance for Needy Families [TANF] (formerly Aid to Families with Dependent Children [AFDC] repealed in 1996)
Part B
Child and Family Services
Part C
Repealed
Part D
Child Support and Establishment of Paternity
Part E
Federal Payments for Foster Care and Adoption Assistance
Part F

6. Foster Care Fund Categories
Maintenance Payments
“Administration”
SACWIS
Training
Demonstrations

7. Basic Requirements of IV-E
To be eligible under IV-E, expenditures must be:
On behalf of an eligible child:
Who meets certain removal and placement standards, and
Who’s family at the time of removal would have been eligible for AFDC on July 16, 1996.
Who resides in an eligible setting:
A licensed family foster home, or
A licensed child care institution.

8. Foster Care Administration Penetration Rate X 50% with some exceptions
In-Placement Administration
Case Planning and Management
Eligibility Determinations*
Provider Management
Agency Management
Candidate Administration Costs

9. Allowable Administrative Costs
(1) Eligibility, fair hearings and appeals (2) The following are examples of allowable administrative costs necessary for the administration of the foster care program: (i) Referral to services; (ii) Preparation for and participation in judicial determinations; (iii) Placement of the child; (iv) Development of the case plan; (v) Case reviews; (vi) Case management and supervision; (vii) Recruitment and licensing of foster homes and institutions; (viii) Rate setting; and (ix) A proportionate share of related agency overhead. (x) Costs related to data collection and reporting.

10. Non-Allowable Administrative Costs
(3) Allowable administrative costs do not include the costs of social services provided to the child, the child's family or foster family which provide counseling or treatment to ameliorate or remedy personal problems, behaviors or home conditions.

11. Foster Care Maintenance (Cost times FMAP for IV-E Eligible Children in IV-E Eligible Settings)
The term “foster care maintenance payments” means payments to cover the cost of (and the cost of providing) food, clothing, shelter, daily supervision, school supplies, a child’s personal incidentals, liability insurance with respect to a child, reasonable travel to the child’s home for visitation, and reasonable travel for the child to remain in the school in which the child is enrolled at the time of placement. In the case of institutional care, such term shall include the reasonable costs of administration and operation of such institution as are necessarily required to provide the items described in the preceding sentence
Separate FMAP for Maintenance paid under State-Tribal Agreements

12. Foster Care Maintenance From Child Welfare Policy Manual (CWPM), continued
(3) Reasonable costs of administration and operation in an eligible institution: Factors related to the allowability of costs therefore include: 
(a) The institution must meet the definition of a "child-care institution" in section 472 (c)(2) of the Act. Costs borne by child placing agencies are not eligible for FFP. 
(b) The costs of administration and operation must be "necessarily required to provide the items described in [paragraph 475 (4)]." Thus, the proportional cost of a bookkeeper, food workers, and supervisor of cottage parents for the institution would be allowable. The costs of providing counseling or diagnosis of illness by a social worker or nurse or costs of the staff of a parent agency not employed by the institution would not be allowable. 
(c) The costs must be "reasonable", that is, no more than the customary costs for performing similar functions in similar institutions, e.g., in size, and type of children, such as handicapped children. 
(e) The costs must be allowable under 45 CFR Part 75 (Uniform Administrative Requirements)

13. What is this thing we call Waiver?
Requirements for an “eligible child” and an “eligible placement” were waived so that Title IV-E funds could be spent on any child / family and any child welfare purpose
In exchange, Florida agreed to a capped allocation with annual automatic increases plus “triggers” to adjust the allocation if actual levels significantly exceeded estimates
All waivers must end 9/30/2019

14. Bottom line
Without the Title IV-E Waiver, we can only claim Title IV-E for children:
In licensed care only (i.e. family foster home, residential group care)
Who met all of the Title IV-E requirements
For room and board and related costs only (e.g. case management and related functions)
We cannot claim for:
Children placed in unlicensed settings (e.g. relatives, non-relatives)
Children remaining with parents including those who have been reunified
Social services such as mental health assessments, parenting, etc.

15. Path Forward Initiatives

16. Path Forward Overview/Initiatives
When Florida transitions back to traditional Title IV-E claiming, we will be unable to earn $90m of our current Title IV-E Foster Care budget
42% of waiver funds are spent on non-IV-E eligible services – 42% of $188m = $80m we can’t earn
Reduced eligibility rate since waiver began, outdated cost allocation practices results in $10m we can’t earn
Initiatives – “Expanding the IV-E Footprint”
Extended Foster Care – eliminates $7m deficit in Independent Living
Level 1 Licensing / Guardianship Assistance – about $20m*
Candidacy – about $40m*
Eligibility rate improvement – about $10m
Remaining $20m gap was funded during last session by recurring general revenue

17. Title IV-E Administration As-is - $90m gap
Licensed Care
Relative &
Non-Relative Care
In-Home
68% eligibility rate
+ 50% Federal Financial Participation

18. Title IV-E Administration Candidacy – close gap by $40m
Licensed Care
Relative &
Non-Relative Care
In-Home
68% eligibility rate
+ 50% Federal Financial Participation
68% eligibility rate
+ 50% Federal Financial Participation

19. Title IV-E Administration Level 1 Licensing – close gap by $20m
Licensed Care
Relative &
Non-Relative Care
In-Home
68% eligibility rate
+ 50% Federal Financial Participation
68% eligibility rate
+ 50% Federal Financial Participation

20. Title IV-E Administration Eligibility Rate Improvement – close gap by $10m
Licensed Care
Relative &
Non-Relative Care
In-Home
72% eligibility rate
+ 50% Federal Financial Participation
72% eligibility rate
+ 50% Federal Financial Participation

21. Path Forward Title IV-E Candidacy

22. Administrative Costs for “Candidates”
State option that allows claiming for children who are at imminent risk of removal from the home, only if— (A) reasonable efforts… are being made to prevent the need for, or if necessary to pursue, removal of the child from the home; and (B) the State agency has made, not less often than every 6 months, a determination (or redetermination) as to whether the child remains at imminent risk of removal from the home.

23. Florida’s Approach to Candidacy
Identification of candidate: When present or impending danger are identified, Florida Statute indicates 2 options – remove child or implement safety plan with caretakers to prevent removal. Therefore, any child with a safety plan receiving in-home services should meet definition (including reunifications) Documentation of candidate: Current safety plan that has been updated within prior 6 months At a minimum, all children who are being served in-home and considered unsafe (including reunifications) should meet the definition of a foster care candidate

24. Path Forward Level 1 Licensing and Title IV-E Guardianship Assistance Program (GAP)

25. Guardianship Assistance Program - Overview
The "Guardianship Assistance Program" is a program that provides benefits to a child's guardian on behalf of the child. Benefits may be in the form of a guardianship assistance payment, a guardianship nonrecurring payment, and / or Medicaid coverage.
Similar to the current Relative & Non-Relative Caregiver Program.
Available when a relative/fictive kin agrees to accept permanent guardianship of a child in foster care, as long as the caretaker has been licensed as a foster parent for 6 months.
Payments continue until the child turns 18 years old as long as the guardian has custody of the child.
Annual re-determination required.

26. Guardianship Assistance Program – Florida Implementation
Created Level 1 license option available to all relatives / fictive kin
Child specific
Non-safety requirements can be waived
Monthly payments amount to $333 per month vs current program of about $260 per month
Reduced training requirements
Process may begin immediately upon placement of child – do not have to wait for adjudication so benefits may begin sooner.
A family is still eligible for benefits if the child and caregiver live or move out of state
Available as long as relative has custody of child (i.e. until child is reunified, changes placement, or relative accepts permanent guardianship and moves to GAP program)

27. Family First Prevention Services Act (FFPSA)

28. FFPSA - Overview
The Family First Prevention Services Act was passed into law on February 9, 2018 as part of the Bipartisan Budget Act of 2018.
The law expands the use of federal Title IV-E child welfare entitlement dollars to prevent entry into foster care, and it restricts funds for out-of-home care that is not a foster family home.

29. FFPSA - Impact Areas Prevention Services Provisions
Congregate Care Provisions
Other Provisions
IV-B Changes

30. Prevention Services – the Option
Allows states to receive open-ended entitlement (Title IV-E) funding for evidence-based prevention services
Who: Children at imminent risk of placement in foster care and their parents or kinship caregivers, and pregnant and parenting youth in foster care are eligible.
No income test for eligibility
What: Eligible prevention services are mental health, substance abuse treatment, and in-home parenting skills
How Long: Services are allowable for up to 12 months, with no limit on how many times a child and family can receive prevention services if the child continues to be at risk of entry into foster care. Services must be evidence- based and trauma informed.

31. Prevention Services – the Funding
When: Title IV-E reimbursement for eligible prevention services can begin on October 1, 2019, if state chooses option. Delinking Eligibility from AFDC: The new Title IV-E prevention services, as well as training and administrative costs associated with developing these services, has no income test. Non-Supplantation: New federal funds for prevention services are intended to augment, not supplant, state funding for prevention services. MOE: MOE will be set at FY2014 spending for these same prevention services for candidates for foster care. Federal reimbursement: 50% initially, then moves to FMAP

32. More about Prevention Services
Must be performed under a trauma-informed framework
Must meet general practice requirements
Must meet the requirements for being a promising, supported, or well- supported practice
At least 50 percent of the expenditures for provision of prevention services and programs in each FFY must be for those that meet the “well-supported” practice criteria

33. Candidacy Comparison Current Law FFPSA Imminent risk of removal
Imminent risk of entering foster care
Identified in defined case plan, IV-E eligibility form or court order
Identified in prevention plan
Absent preventive services, foster care is the planned arrangement for the child
Service needs directly related to the child’s safety, permanence, or well-being or to prevent entry
Renewed every 6 months
Not more than 12 months
No services
Administration 50% match subject to penetration rate
Specified services 50% match, with some restrictions
Administration 50% match, not subject to 1996 AFDC eligibility

34. Ensuring Appropriate Placements in Foster Care – the Limitation
When: Effective October 1, 2019, however, a state may delay for up to 2 years but the OPTION for prevention services claiming cannot be selected until the limit on RGC is implemented
Federal Reimbursement: FMAP for eligible children after 2 weeks in care only if in a specified setting

35. Foster Family Home – per Program Instruction
The statute now limits the definition of foster family home to a “home of an individual or family,” and requires that the foster parent resides in the home with the child. This means that the term may no longer include “group homes, agency-operated boarding homes or other facilities licensed or approved for the purpose of providing foster care...” as previously permitted in the regulatory definition at 45 CFR (a) if that facility is not the home of an individual or family.

36. Types of “non-Foster Family Homes”
Not Specified
Specified Settings
Licensed Residential Family- Based Treatment Facility
Supervised Independent Living (age 18+)
Prenatal Postpartum or Parenting Supports
Victims of
or At Risk of Sex Trafficking
Qualified
Residential
Treatment
Program
(QRTP)

37. Not Specified Setting Specified Settings Not Specified
Beginning with the third week of placement, no federal funds are to be made for maintenance in a setting that is not a specified setting or a licensed residential family-based treatment program for substance abuse
Federal funds for administrative costs remain available for traditionally allowable costs including case management
Costs for the administration and operation of a facility are part of the maintenance payment and not allowable, beginning with the third week

38. Licensed Residential Family-Based Treatment Facility for Substance Abuse
Specified Settings
Not Specified
Child is eligible for maintenance payments without regard to AFDC eligibility
For a period of not more than 12 months
Placement and care requirements remain in effect
Recommendation for placement specified in the child’s case plan before placement
Treatment facility provides, as part of the treatment for substance abuse, parenting skills training, parent education and counseling
The facility must be licensed but the IV-E licensing and background check requirements for CCIs do not apply
The maintenance payments may not include costs of administration and operation of the facility

39. Supervised Independent Living
Specified Settings
Not Specified
For youth age 18 and older
A title IV-E agency has the discretion to develop a range of supervised independent living settings which can be reasonably interpreted as consistent with the law, including whether or not such settings need to be licensed and any safety protocols that may be needed
For example, a title IV-E agency may determine that when paired with a supervising agency or supervising worker, host homes, college dormitories, shared housing, semi-supervised apartments, supervised apartments or another housing arrangement meet the supervised setting requirement” (section 472(k)(2)(C) of the Act).

40. Prenatal, Postpartum or Parenting Supports
Specified Settings
Not Specified
The facility must meet the statutory definition of a Child Care Institution (private institution or public institution with not more than 25 children which is licensed by the state)
The statute does not provide additional parameters for placing a child in this setting and the Children’s Bureau is not defining it further.

41. Victims of, or At Risk of Sex Trafficking
Specified Settings
Not Specified
A setting providing high-quality residential care and supportive services to children and youth who have been found to be, or are at risk of becoming, sex trafficking victims as identified by the title IV-E agency.
The facility must meet the definition of a CCI.

42. Qualified Residential Treatment Programs
Specified Settings
Not Specified
A QRTP placement is a specific category of a non-foster family home setting
Must meet detailed assessment, case planning, documentation, judicial determinations and ongoing review and permanency hearing requirements for a child to be placed in and continue to receive title IV-E FCMPs for the placement
Must be licensed, criminal record and child abuse and neglect registry checks must be completed
Must be accredited by one of the independent, not-for-profit organizations specified in the statute or one approved by the Secretary (CARF, JCAHO, COA, or any other approved by the Secretary)

43. Qualified Residential Treatment Programs Additional Requirements
Assessment by a qualified individual. – Must be completed within 30 days. If not completed, no federal funds shall be made (not even for 14 days)
Qualified individual. A trained professional or licensed clinician who is not an employee of the IV-E agency or affiliated with any placement setting (may be waived)
Court Review – Court review required within 60 days of start of placement
Long-term placements. For every QRTP the child is placed in for more than 12 consecutive months or 18 nonconsecutive months (or, in the case of a child who has not attained age 13, for more than six consecutive or nonconsecutive months), the title IV-E agency must maintain documentation in the child’s case plan and make it available for federal inspection and/or review upon request, during a title IV-E eligibility review, joint planning, or a partial review

44. Qualified Residential Treatment Programs Additional Requirements
Trauma informed treatment model is required
Registered or licensed nursing staff and other clinical staff are required, on-site as consistent with the treatment model and available 24/7
As appropriate, program must facilitate participation of family members in treatment and facilitate outreach to family members including siblings, biological family and fictive kin
Provides discharge planning and family-based aftercare support for at least 6 months post-discharge
Administrative Costs may be claimed by the IV-E agency regardless of whether QRTP requirements are met. If QRTP requirements not met, administrative costs remain but costs associated with administration and operation of the QRTP are not allowable

45. Transitioning to the FFPSA Provisions Related to Specified Settings (sec. 472(k))
From Program Instruction:
Title IV-E agencies may claim 14 days of title IV-E FCMPs each time a child is “placed in a child care institution” regardless of whether the child has had previous CCI placements during his or her foster care episode (section 472(k)(1) of the Act).
The setting limitations described above apply to new placements in these settings made on or after the effective date of the provisions in section 472(k) of the Act. Title IV-E agencies may claim title IV-E FCMPs for a child placed in a CCI prior to the effective date of section 472(k) of the Act for as long as the eligible child continuously remains in that setting. If the child later leaves this setting and enters a different non-foster family home setting, the title IV-E agency must apply section 472(k) of the Act.

46. Federal Guidance

47. Program Instruction / Other Information
July 9, 2018 – PI “To provide instruction for: 1) changes to the title IV-E plan requirements as a result of the Family First Prevention Services Act that are effective as of January 1, 2018 and later; and 2) delayed effective dates for title IV-B/E plan requirements.”
November 30, 2018 – PI “To instruct state title IV-E agencies on the title IV-E prevention program requirements”
Letters from Commissioner Milner

48. PI-18-07 Did not provide information on prevention services
Requested that states identify whether they will request delay and how long the delay will be
Florida requested the full 2 year delay

49. PI-18-09
Indicated that “the state is not required to provide services in all counties and geographic locations in the state, nor is the state required to provide the same type of prevention services in the elected jurisdictions.”
Outlined detailed requirements for State Plan
Service description and oversight
Evaluation strategy / waiver request
Monitoring of child safety
Consultation and coordination
Workforce support and training
Prevention caseloads

50. PI-18-09, cont’d Provided more detail for Prevention Plan
For candidates, the child’s prevention plan must:
identify the foster care prevention strategy for the child so that the child may remain safely at home, live temporarily with a kin caregiver until reunification can be safely achieved, or live permanently with a kin caregiver; and
list the services to be provided to or on behalf of the child to ensure the success of that prevention strategy.
For pregnant or parenting foster youth, the prevention plan must:
be included in the youth's foster care case plan;
list the services to be provided to or on behalf of the youth to ensure that the youth is prepared (in the case of a pregnant foster youth) or able (in the case of a parenting foster youth) to be a parent; and
describe the foster care prevention strategy for any child born to the youth

51. PI-18-09, cont’d
Defined a candidate for foster care as a child who is identified in a title IV-E prevention plan as being at imminent risk of entering foster care, but who can remain safely in the child's home as long as the title IV-E prevention services that are necessary to prevent the entry of the child into foster care are provided. Includes a child whose adoption or guardianship arrangement is at risk of a disruption or dissolution.
Indicated that no further definition of candidate would be provided
Identified some specific data requirements
the specific services provided to the child and/or family;
the total expenditures for each of the services provided to the child and/or family;
the duration of the services provided;
if the child was identified in a prevention plan as a “child who is a candidate for foster care”:
the child’s placement status at the beginning, and at the end, of the 12-month period that begins on the date the child was identified as a “child who is a candidate for foster care” in a prevention plan; and
whether the child entered foster care during the initial 12-month period and during the subsequent 12-month period; and
basic demographic information

52. PI-18-09, cont’d
Identified 1st 10 programs to be evaluated by the Title IV-E Prevention Services Clearinghouse (future programs evaluated on rolling basis) based on meeting at least two of the following conditions:
(1) recommendation from State or local government administrators in response to the FRN;
(2) rated by the California Evidence-Based Clearinghouse;
(3) evaluated by Title IV-E Child Welfare Waiver Demonstrations;
(4) recipient of a Family Connection Discretionary Grant; and/or
(5) recommendation solicited from federal partners in the Administration for Children and Families, Health Resources and Services Administration, the National Institutes of Health, the Centers for Disease Control and Prevention, the Office of the Assistant Secretary for Planning and Evaluation, and the Substance Abuse and Mental Health Services Administration.

53. PI-18-09, cont’d Mental Health: Substance Abuse:
Parent-Child Interaction Therapy
Trauma Focused-Cognitive Behavioral Therapy
Multisystemic Therapy
Functional Family Therapy
Substance Abuse:
Motivational Interviewing
Families Facing the Future
Methadone Maintenance Therapy
In-Home Parent Skill-Based:
Nurse-Family Partnership
Healthy Families America
Parents as Teachers
Kinship Navigator Programs:
Children’s Home Society of New Jersey Kinship Navigator Model
Children’s Home Inc. Kinship Interdisciplinary Navigation Technologically-Advanced Model (KIN-Tech)

54. PI-18-09, cont’d Mental Health: Substance Abuse:
Parent-Child Interaction Therapy WELL SUPPORTED
Trauma Focused-Cognitive Behavioral Therapy PROMISING
Multisystemic Therapy (MST-CAN) Does not currently meet criteria
Functional Family Therapy WELL SUPPORTED
Substance Abuse:
Motivational Interviewing ???
Multisystemic Therapy (MST) WELL SUPPORTED
Families Facing the Future SUPPORTED
Methadone Maintenance Therapy ???
In-Home Parent Skill-Based:
Nurse-Family Partnership WELL SUPPORTED
Healthy Families America ???
Parents as Teachers WELL SUPPORTED
Kinship Navigator Programs:
Children’s Home Society of New Jersey Kinship Navigator Model Does not currently meet criteria
Children’s Home Inc. Kinship Interdisciplinary Navigation Technologically-Advanced Model (KIN-Tech) Does not currently meet criteria

55. June 6 Letter – alternative path?
Allows for transitional payments until Clearinghouse can review and rate a program or service
IF state submits sufficient documentation that the state conducted the independent systematic review
Clearinghouse makes final determination of whether program is promising, supported, or well-supported
Further guidance to be provided in coming weeks

56. Activities / Next Steps

57. Activities
Creation of Executive Steering Committee chaired by Teri Saunders and Melissa Jaacks
Legislative work!
On-site visits to each CBC to review Path Forward initiatives
Significant sub-committee work related to level 1 licensure and GAP (Teri Saunders and Traci Leavine)
Region trainings with DCF licensing staff, CBC’s and RGC providers on FFPSA (Zandra Odum)
Significant work with FCC RGC sub-committee to prep for FFPSA
Significant work reviewing safety plans to prep for Candidacy (Mike Bryant and Ginger Griffeth)

58. Next Steps We are live with level 1 licensing!
Candidacy clean-up still in process (safety plans)
FSFN eligibility fixes late September
Extended foster care eligibility clean-up in process
Webinar on how to separate rates for licensed care
CBC Cost Allocation Plan template
Lots of back and forth with ACF
Measure and ADJUST
FOCUS on FFPSA and prepare for next session

59. Wrap UP